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If you don’t know by now then do something else. Only reason to go into this field is if your parents own a Linac or if you’re a masochist.
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Started by Gfunk6
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…I’m so confused why people on here saying this. A new grad from my program just took an offer for 800k in rural Kansas. Another new grad in Georgia took an offer for 650k at 4 days a week. The average for rad onc is equal to or higher than gastro on every single national survey. Not to mention the lifestyle is leagues better than gastro.
You’re telling me gastro rural is making 1.2-1.8 mil? The 90th percentile of gastro on mgma is 900k.
The jobs information I get on this site confuses me.
There is some exaggeration that you will see here.
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Correct
The rural rad onc’s I know are hospital employed, except the Korean guy in Nebraska who advertised on Astro a while back
The rural GI doc’s I know are not hospital employed
The rural med onc doc I rotated with made $2.4m. All these rural base $600k salaries look nice until you’ll realize family med can make $600k in rural if they run a busy and efficient office. The real money comes from ownership and technicals. Most rural GI docs owns endo suites. Unfortunately not many rural rad oncs own linacs
Good luck finding these numbers with rad onc! If your number one priority is making as much money as possible. Do neurosurgery, CTS, Ortho, plastics or at very least radiology
Attachments
But if you want a balance of good to great income + good to great QoL, then rad onc could be a good fit. Just need geographic flexibility with that 1st job.
These types of positions (very difficult locations to staff) used to be advertised for rad onc 10 to 15 years ago ($1 million salary even back then). You don't see that anymore at all.
Who you gonna believe, the MGMA or your lying eyes. MGMA rad onc median salary is up more percent than almost any other specialty last 15 years. Now how you square that with a huge uptake in hypofrac, rad onc oversupply, ASTRO saying Medicare reimbursement is down 25%…
¯\_(ツ)_/¯
Same here.
I believe them. I know lots of employed rad oncs at $60-65/wRVU. I know PSA groups that are in range for MGMA.
With that said, I don't know a lot of rad oncs in coastal cities major first tier metro.
But in third tier cities and fly over country I completely believe MGMA.
Makes less than… MGMA median? There’s a 50% chance I do, before you check me out. I presume 50% of the people who you know make less than MGMA median, or your anecdotal experience may not have a good statistical basis.
ive seen this dog and pony show every time anything about salary is posted here. you can choose to disbelieve them. or maybe your analyses (have seen them here and X) are....flawed
the people I talk to are all 5-10 years out. starting salaries are below MGMA median (though not always).
the people I talk to are all 5-10 years out. starting salaries are below MGMA median (though not always).
I’m just saying everybody seems to make the MGMA median. And a high school level stats book’s dog and pony show says this is impossible.
Most people I know (hospital employed, academic, PP) started well below MGMA median (like 100-200k). 3 years in, I will make above the MGMA median. There are some outliers (rural hospital employed comes to mind) that are the exception.
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I mean not everyone I know is making mgma median for sure. Two new grads from our program are making 350k and 300k. However they’re working in two major cities that everyone in America would know the name of (actual large cities, not just “technically a city”) and are in academics, with 3-3.5 days clinical and 1.5-2 days deserved for research. The guys that chose to go completely rural to maximize earning are making between 600-850k for 4-4,5 days per week. Again, this is first year post grad, they just graduated this June. I’m technically not even at a t10 program, just a t20.
I just try to get everyone to think a little more precisely about these issues and couple them with these kinds of stories, which are anecdotal, and the hard factual data of declining reimbursement and XRT utilization. For 2026, for the 16 players on the Miami Heat, the average salary is 13 million and the median salary is 5 million. I find rad oncs think they are going to make average, whereas they are not likely to make average, and our salary distributions follow more the Miami Heat versus a bell shaped curve.
Rural rad onc is taking an outlier job to get outlier salary. Herschel Walker did the same thing when he joined the US Football League. I predict high paying rural rad onc jobs will go the way of the USFL especially if the 2026 proposed rule comes to be.
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right I think we can all agree on this (though it does seem like many of us are treating some things more often even if bread and butter breast and prostate fractions are down, im treating WAY more mets and treating each patient multiple times more often than I did when I started in practice nearly a decade ago now). but I think where this falls apart is thinking there is a clear 1:1 relationship between utlilization/reimnursement and salary in an increasingly employment-dominant field.
Like, if the salaries are what they are in multiple salary surveys, over and over again, perhaps you should stop pointing to medicare numbers or any other numbers to say 'the numbers HAVE to be wrong' and rather consider they may not be totally connected?
that is the main crux of what I am trying to say.
To beat a dead horse, yes the rad onc mgma and aamc numbers are accurate, the median rad onc is hospital or academic employed, no the mgma survey data doesn’t capture private practice, yes other specialists like many radiologists heme onc’s and even some FM docs and a diminishing and small number of rad onc’s make significantly more than survey data would suggest
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How do you know? What is "accurate"? I could sample 10 rad onc's and give you a median salary, and it would be "accurate."
Which are you more skeptical about: that lidocaine improves overall survival in early breast cancer more than regional nodal irradiation or tumor cavity irradiation, or that MGMA data describes rad oncs' salaries nationwide. I'm just trying to make people think, and I try to stick to verifiable data to do so. MGMA doesn't give good data, but I use what they give...
This is true in that now >50% of all rad oncs are hospital (which always includes academic) employed.
This is not true.
I understand what you are trying to say, completely. But it doesn't square with what we know about economics in any other arena, at least not in the long term. Don't buy stock in a company whose profits decline year over year and keep giving its executives and workers annual pay raises and bonuses. However, it's far easier to get a publicly traded company's annual report than it is to get fulsome data in rad onc in the same way.
The thing almost every field of medicine is making more year over year despite cuts to government reimbursement. As a whole, physician wages are up (thought typically not on par with inflation) due to rise in productivity. As someone else here said, there’s been a sharp rise in cases my institution treats for nonalignment cases that has offset hypofractionation. Osteoarthritis in particular has went from near 0 just a few years ago to not infrequent anymore here.
That is true, but rad onc has been an outlier in many respects including reimbursement. ASTRO says something like 25% cut over the last twenty years. Plus we have cut average fractionation by about a third last 20 years. And we have thrown more rad oncs in the mix (versus any other specialty) to split up the ever shrinking pie, pie crust, whipped cream topping, etc. But as Jeff Goldblum said in Jurassic Park “Life finds a way.”
I look at data like this and wonder. Median Eastern vs Southern? 545 vs 578. 75%ile? 782 vs 671.
Is that just a sign:
1) the numbers are very low
2) Eastern radoncs are better at screwing the young
3) Por que no los dos?
I want to ask, can anyone who sees this post please tell me a case of someone who is struggling to find a job in rad onc right now, and getting low salaries in bad locations? I’d love to hear some examples. This isn’t sarcasm, I actually really would like to know these anecdotes. Because outside of surveys that’s all we have.
I just found out today and wanted to share, as one of the perceptions here seems to be that in order to make past 500k, you have to be in some remote village.
A Resident who graduated in June, at a program one of my friends is currently a resident at (ranked between 30-50 if relevant) got a job at 750k for 4.5 days a week in a southwestern US at a city with >500k population.
Also, the 550k job in LA (2 positions) is still open and they are actively searching (not just listing for internal purposes), as another poster here attested to.
I just found out today and wanted to share, as one of the perceptions here seems to be that in order to make past 500k, you have to be in some remote village.
A Resident who graduated in June, at a program one of my friends is currently a resident at (ranked between 30-50 if relevant) got a job at 750k for 4.5 days a week in a southwestern US at a city with >500k population.
Also, the 550k job in LA (2 positions) is still open and they are actively searching (not just listing for internal purposes), as another poster here attested to.
Check in on that resident in 2028 or so...
I have known docs who lost their job and could not find another one in the same state. Huge problem if you are divorced or have kids in school. Allows employers to treat you badly.
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This is likely one of the best job markets for RadOncs as far as geography goes and relative pay in specialties, and will probably be the last good job market for RadOncs. I don't know if it will last until you start practicing in the early 2030s. I don't think it is wise to look at outlier jobs in an outlier year and think that something similar will be there for you. Go into the field if you would be happy making that amount or less in fly over states if everything comes crashing down like it has in the past.
A few points-
1. Great job market, currently.
2. RadOncs make good pay relatively, but may not last.
3. Radiation oncology is one of the most targeted fields for decreasing compensation.
4. Geographic flexibility is worse than most specialties, even in a good RadOnc year.
5. Life style is relatively good in RadOnc residency, but I would argue all specialties can have good life style in attending practice unless you are a very emergent on call specialty like transplant or trauma, but at that point you chose that life.
I like this field more than any other field. If you rely on outlier outcomes in location and money as the reason to go into a field, that is not good. Especially in a field that fluctuates significantly over time and has more headwinds now than anytime in the past. Something to consider.
Read these 2 papers to get some perspective on the changes of the workforce over time.- Chicken little or the goose-is-cooked in 2021 and the workforce analysis from 2023, both by Shah et al.
A few points-
1. Great job market, currently.
2. RadOncs make good pay relatively, but may not last.
3. Radiation oncology is one of the most targeted fields for decreasing compensation.
4. Geographic flexibility is worse than most specialties, even in a good RadOnc year.
5. Life style is relatively good in RadOnc residency, but I would argue all specialties can have good life style in attending practice unless you are a very emergent on call specialty like transplant or trauma, but at that point you chose that life.
I like this field more than any other field. If you rely on outlier outcomes in location and money as the reason to go into a field, that is not good. Especially in a field that fluctuates significantly over time and has more headwinds now than anytime in the past. Something to consider.
Read these 2 papers to get some perspective on the changes of the workforce over time.- Chicken little or the goose-is-cooked in 2021 and the workforce analysis from 2023, both by Shah et al.
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Its crazy to think about the workforce analysis in 2025 when you now have to layer on top: AI (RVU inflation), a new type of mid-level, completely restructured codes, exploding costs of equipment that bring unclear benefit to patients, trying (weakly) to leave medicare with no real plan B.
If a student came to me with a priority for high, stable pay, Id praise them for being honest about their priorities. Then Id tell them to consider other fields unless they feel they were born to be a Rad Onc.
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How do you think AI will impact this field? And is that new midlevel thing confirmed? I thought it was just a proposal.
AI will make it so RadOncs can do more work in less time. Some institutions are already using the new midlevel. The proposal is that it becomes more widespread and I expect it to happen. Both of these things have potential to significantly worsen the job market for physicians.
Agree with NMS. I think creation of a new midlevel without a need has a chance of driving down pay since most of us are employees.
The paper I asked you to read talks about it some: "Therefore, it is possible the upper RVU range of the model will need to be increased (and can be using the ASTRO Workforce Modeling Tool) to truly reflect the possible elasticity in the years to come, as well as accounting for increased efficiencies, allowing for greater wRVU generation (eg, autocontouring, use of advanced practice providers). In the most extreme elasticity scenario (labeled worst-case scenario in Table 2), these parameters translated into a substantial oversupply of 1300 ROs in 2030 as ROs would increase their wRVUs to match that of the highest region (potentially to compensate for reimbursement reductions, loss of technical revenues from hypofractionation, loss of RT indications as well as increased efficiencies that would allow for this without drastically increasing hours required)."
This means as we become more efficient, you will need less of us, whether it be from AI or midlevels or decreasing reimbursement making physicians see more patients and stop hiring.
While it doesn't seem like it's going to happen enough by 2030, the AI will only continue to improve workflows and the use of a new advanced practice provider will both eventually reduce the need for physicians. The baseline model said that by 2030, we will be stable with where we were when there were concerns of oversupply and that the authors believe there is a chance it continues to worsen into the 2030s.
Now you can read all of that and still think "won't happen to me". It won't happen to any of us in our own minds because we are all special. It will be someone else, right? When your neighbor loses a job it's a recession, when you lose a job it's a depression. But maybe there are more and more new indications that offset decreasing indications and new efficiencies. Maybe pay continues to stay high for the next 30 years even though we are constantly targeted for pay cuts. Maybe the job market doesn't become extremely tight and competitive like it has in the past.
Like NMS said I would also recommend considering other specialties unless you feel that this is the only thing you want to do. No one can truly predict the future, but so many things are happening that convince me I will some day be working the same job for 250k, and I'm fine with that because I like the job. Do you like the job that much? If you do then apply. If you think you're going to be making 600k in LA or Manhattan you'll probably be on SDN in the 2030s warning people.
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Due to residency overexpansion, radoncs can almost never increase their patient load. If ai makes primary care more efficient, there is an infinite supply of patients ready to take up the space, come through the door. Same true for radiology- docs could read more scans. Average radonc will still be stuck with 4 new pts/week- now at less reimbursement due to cms efficiency discounts-no matter how efficient the workflow becomes. The rest of medicine is very elastic.
Astro who sponsored the residency overexpansion, now is looking to throw in an advanced provider to further worsen the situation.
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I don’t think that would ever happen. I think the job market and compensation are somewhat separate. Rad onc is still very profitable for hospitals (even with all the CMS changes) so hospitals will pay top (or at least high medium) bucks to rad oncs. Now what might happen is, due to midlevel scope creep, instead of paying two rad oncs $600k, they’re gonna pay one rad onc $700k and pay $150k to the midlevel and have the rad onc supervise. Again, this is very simplified. Reality is more complex. I think the job market (in term of job availability) will take a major hit but compensation wise, i think the ceiling will drop significantly but the median probably stay relatively the same.
I'm saying my specific salary will drop to that, the median will probably drop also, but idk what it will be. That is how supply and demand works. You see it in big cities in a lot of specialties. This is why EM in Colorado make significantly less than EM in another part of the country, and Anesthesia and radiation make less in desirable areas. It's basic economics and does happen. Once jobs become scarce in areas, employers can offer less money because someone will take the job and it improves their bottom line.
There is no confirmation required for an APRT 🙂 They already exist and people are hiring them, I've seen some job postings. Whether or not this actually impacts the job market in the future is anyone's guess. Other mid-levels already exist in RO and supervision rules limit what they can do independently. I don't think its a huge issue.
For AI, it's about case load. A lot of RO practices have anxiety about case volumes. The anxiety can be for various reasons, but a lot of ROs would prefer to be busier. AI can let you be a lot busier before it starts to impact your QOL.
This is what I personally think about when my practice starts to wonder whether or not we should hire.... how will it affect my pay and QoL? Right now I think my practice can absorb a lot of work before we feel the need to hire.
I suspect that part of the "good job market" is a post-COVID bubble where people are trading some pay for QoL, retiring, going part time, etc. I think @CurbYourExpectations posted this earlier (?), but that cant go on forever.
The SCAROP data already implies that the average academic RO is not that busy. How many more not-busy junior ROs can the academic departments absorb? Even if the networks expand by absorbing rural/community departments "creating" more jobs, at what point will those jobs just become undesirable due to pay, geography, and/or something else?
I am not sure we will see individuals getting pay cuts, that is uncommon in general. My concern is that people could in theory start going unemployed, forced in to fellowships, or crappy academic jobs. Or you just get stuck in a crappy job with no where really to go.
There is no data on this, but I do not get the impression that juniors are highly mobile in this field with a lot of great jobs to choose from after that first contract.
AI has and will continue to allow us to become more efficient. But its not just AI, EMR improvement and consolidation has made patient workup and coordination of care more streamlined. I can simply see more patients today than say 5-10 years ago. My health system and most of my referring provider are on the same EMR, as our most of our regional health systems. For example, I started offering LDRT for OA. Most of my patients already see ortho at our hospital. I can see all their x-rays, find out what treatments they have had, and message their surgeon/mid level provider and let them know about LDRT to generate more referrals. All of this is done within the EMR.
It’s been surprising to me the stories I have heard about systems, or department admins, or department physicists, not allowing their rad onc to treat arthritis. What a wild sentence to type as well.
True, but with respect to the job market, it really depends on where the inefficiencies are located in the workflow. This is going to very a lot from clinic to clinic.
Also "efficiency" with respect to QoL is subjective. I know some docs chillin at 15,000 RVU and some academics that act like they are dying at 5000 RVU.
Does anybody other than the one med student, @allseasons, actually think we’re in a potentially desirable position? I think we all agree and have been agreeing and stating the obvious for years. The glory days are a decade behind us. We all need to hold on for as long as we can and be smart with our money so we can become financially independent ASAP. No one here expects to make more than they do now and no one would be surprised if our incomes are slashed in half over the next decade.
Writ large? No, I don't think rad onc is a desirable specialty for anyone looking toward the future.
Individually however, if you are the lone rad onc left standing in an area where other clinics have closed down you could see an infusion of extra patients/referral streams which could be lucrative if you're paid based on productivity.
Individually however, if you are the lone rad onc left standing in an area where other clinics have closed down you could see an infusion of extra patients/referral streams which could be lucrative if you're paid based on productivity.
I do not know a single rad onc who's been in practice >15y who makes more today than 15y ago. I bet he/she doesn't exist. I sound like God in the book of Jeremiah... "Go up and down the streets of rad onc, search its squares... if you can find but one person who maketh more money over time and seeks the truth, I will tell @allseasons to become a rad onc.”
Lol optimism of youth
I mean, I’ve never been under the impression that rad onc hasn’t gotten worse or that doctors now are making more than ever. As a whole, the heydey of most of medicine outside of psychiatry and perhaps radiology/anesthesia is over.
I mean optho’s average salary has plummeting, Medicare reimbursement has decreased by literally 70% for cataracts over the past 20 years, yet it’s still insanely competitive. Optho used to make far more with less effort and not having to upsell specialized lenses.
I’m not particularly optimistic about rad onc, nor do I expect to make what people did back in 2000. I’m just don’t quite believe the field is doomed as I see on here, and not a single rad onc I have ever met, either in faculty or resident believes what I read here. I've spoken with many across multiple institutions. The amount you see me post on here is less than 20% of the engagement I’ve done within the field to learn about its present state and future. Even the rad oncs on Reddit are far more positive than here. I will say, almost all my interactions are with faculty and residents at top 30 institutions within rad onc, but that’s still a pretty decent number. It’s not like I’m restricting myself to MSK, Harvard, and Anderson.
I absolutely understand the negativity of rad onc doctors that used to make far more doing less, but as someone entering medicine now… what fields exactly am I supposed to do that have the lifestyle and income of a rad onc doctor, especially in residency, other than radiology and dermatology. The 90th percentile of psychiatry around the 10th percentile of rad onc.
Again, I’m not saying I’m just randomly choosing specialties ranked by income, but let’s pretend I have no interests other than income and lifestyle. What should I do? I’m moderately competitive but not insanely so derm is out. I can probably match diagnostic radiology, that’s the edge of how competitive I am. But radiology bored me.
I mean optho’s average salary has plummeting, Medicare reimbursement has decreased by literally 70% for cataracts over the past 20 years, yet it’s still insanely competitive. Optho used to make far more with less effort and not having to upsell specialized lenses.
I’m not particularly optimistic about rad onc, nor do I expect to make what people did back in 2000. I’m just don’t quite believe the field is doomed as I see on here, and not a single rad onc I have ever met, either in faculty or resident believes what I read here. I've spoken with many across multiple institutions. The amount you see me post on here is less than 20% of the engagement I’ve done within the field to learn about its present state and future. Even the rad oncs on Reddit are far more positive than here. I will say, almost all my interactions are with faculty and residents at top 30 institutions within rad onc, but that’s still a pretty decent number. It’s not like I’m restricting myself to MSK, Harvard, and Anderson.
I absolutely understand the negativity of rad onc doctors that used to make far more doing less, but as someone entering medicine now… what fields exactly am I supposed to do that have the lifestyle and income of a rad onc doctor, especially in residency, other than radiology and dermatology. The 90th percentile of psychiatry around the 10th percentile of rad onc.
Again, I’m not saying I’m just randomly choosing specialties ranked by income, but let’s pretend I have no interests other than income and lifestyle. What should I do? I’m moderately competitive but not insanely so derm is out. I can probably match diagnostic radiology, that’s the edge of how competitive I am. But radiology bored me.
Theory: don’t believe SDN
RT for OA was predicted on SDN. Not a single rad onc I met at the time believed SDN then either. The 2025 ASTRO meeting would not be what the meeting is were it not for SDN. (How about SDN predicting a rad onc fall from grace? I could go on.) And the way the scientific method works it takes only one falsifying piece of information to invalidate an entire theory 🙂
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Bloodbath 2013 thread etc predicting the fall from grace of the specialty
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While rad onc residency is less brutal than like of nsgy, gen surg, ortho etc. if you expect 8-4pm and couple hours of studying after, you’d be greatly disappointed when you start residency. The workload of rad onc is much different from other specialties.
Depends on your goals. I know docs that are trying to make as much as they can and retire ASAP. Makes a lot of sense to me and I am a little jealous of that goal in theory even though thats really not for me in practice.
If you think you can tolerate being bored, Id guess radiology will offer you a lot more opportunities to achieve that goal than rad onc.
If you choose rad onc, become a rad onc, and ever get in a spot where you have to locums... check back in with us!
Who do you believe more when it comes to "the truth about the world" 🙂
1. SDN
2. That faculty that trained at an academic place and stayed on, and this has been their only job in their 10 year career.
Most people seem to understand that you shouldnt just openly trust an anonymous internet forum for important information.
But the level of distrust in group 1 is almost as wild as the level of trust in group 2.
